Traumatic Injury Results In Man Literally “Seeing Stars"

The man's strangely stellar rosette cataract, as seen during a slit-lamp examination. Singh et al./BMJ Case Reports, 2018

Aliyah Kovner 19 Dec 2018, 00:20

A 36-year-old from Punjab, India, recently got punched in the face so hard that his eye doctor saw stars. Yes, you read that right. Writing in BMJ Case Reports, ophthalmologists described the plight of an unidentified man who sustained a vision-impairing yet very festive-looking cataract after a fist caught him in the left temple.

Like all cataracts, the star-shape opacity appeared due to damage to the man’s lens capsule – the fluid-filled structure, located right behind the iris, that focuses light after it enters the eye. Composed of specialized cells and collagen, the translucent lens becomes cloudy when proteins in the interior fluid change structure and begin to clump together. These changes occur as a result of chronic UV radiation exposure (i.e., getting older and having not worn sunglasses regularly), genetic factors, certain medical conditions or drugs, and – as in this case – ocular trauma.    

"A traumatic cataract happens any time that an eye injury causes the internal lens of the eye to become cloudy. The lens is about the size of an aspirin tablet, and it may not become completely cloudy," cataract and cornea specialist Dr John Hovanesian, a clinical spokesperson for the American Academy of Ophthalmology, explained to IFLScience. "Sometimes, just a portion of the lens turns feathery white, and sometimes these portions form interesting shapes, like rose petals in this case report from the British Medical Journal."  

And while old-age and disease-related cataracts usually appear as diffuse haziness, trauma-induced cataracts often take on interesting shapes, though special imaging equipment is needed to see them in detail. The star-shape observed in this unfortunate patient is one of the most common and is referred to as a “stellate” or “rosette” cataract. (The other distinctive type of cataract is a "Christmas tree" that appears glittery – who knew eye injuries were so nice to look at?) 

According to the authors, the man began experiencing impaired vision just six to seven hours after he was punched. Rosette cataracts range widely in their time to formation, from immediately after an injury to up to several months later.

When his vision was still worsening two days after the brawl, the patient brought himself into the authors’ eye clinic, where they used a standard eye examination technique to study his lens.

“The slit lamp biomicroscopy of the left eye showed white axial opacities in the form of five distinct quadrangular ‘petals’, giving it a characteristic rosette pattern,” they noted. These oddly beautiful geometric injuries have been documented with as many as 10 "petals", which are known to arise when energy from a direct impact or shockwaves from a nearby impact (like a punch to the temple) ripples through the protein fibers of the lens.

Thankfully, the rest of the man’s eye showed no permanent damage. Following the same procedure used for age-related cataracts, the doctors removed the scar tissue in the lens, as well as the remainder of the fluid, and inserted an artificial lens.

"Regardless of its cause, clouding of the internal lens of the eye can be treated by an ophthalmologist performing cataract surgery, which is replacing the natural lens with an implant," Dr Hovanesian said. "A new lens implant will correct the patient's vision forever."  

One week after surgery, the patient’s vision in the left eye was measured at 20/20. 

 [H/T: Live Science]

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